Monday, December 5, 2011

Why Life Expectancy Can't Be Used to Judge Health Care.

Here is how the infamous Daily Mail, a paragon of tabloid journalism, reports on health care in the United States. “The study said Americans pay more than $7,900 per person for health care each…but still die earlier than their peers in the industrialized world.”

Now, perhaps this sort of bad reporting is not the Daily Mail’s fault. They do claim they get this from the Organization for Economic Cooperation and Development.

It just doesn’t work to compare life expectancy rates to quality of health care. There are dozens of factors involved in life expectancy. The paper reports that in America the average life expectancy is 80.6 now. The highest in the world is 86.4 in Japan.

A lot of people are trying to claim that this proves that state-run health care is better because people in those nations live longer. Well, the nation that I keep having thrown at me regarding nationalized health care is the United Kingdom. Their life expectancy is lower than for the United States. While the Daily Mail mentions life expectancy in the UK, it never divulges what it is in the UK.

Using life expectancy to judge health care is similar to using the supply of apples to determine the price of oranges. Life expectancy is more about life style than it is about health care.

Obesity in the US is much higher than in many other countries. Higher obesity rates lower life expectancy. It does so regardless of whether health care is brilliant or pathetic.

Even something as mundane as driving cars impacts life expectancy. The reality is that a lot of Europeans can’t afford to drive due to high taxes, lower wages, and higher prices for cars and gas. When I lived in Europe I traveled by train, which was difficult, inconvenient and inefficient. Now, I drive in the United States.

For every 100,000 residents in the United States 12.3 are killed in car accidents. In the UK it is only 3.59. In Sweden it 2.9; Switzerland is 4.7; Germany is 4.5; and Netherlands is 8.6. Traffic accidents lower life expectancy. But few people would argue that the health care system causes car accidents. If you increase the number of drivers you will increase the number of people who die in car accidents. Because Americans are more able to afford cars, they drive more. And the more they drive the more likely they are to be killed in car accidents. And when they are, the life expectancy rate goes down.

Crime is not caused by health care, yet crime rates directly impact life expectancy, sometimes dramatically so. According to the Daily Mail, the ten nations with the highest life expectancy rate are Japan, Spain, Switzerland, France, Australia, Korea, Israel, Finland, Sweden and Iceland. They all exceed life expectancy in the U.S. What are the murder rates in those countries? Surely murdering people lowers their life expectancy, and the higher the murder rate, the lower the life expectancy.

According to Wikipedia, here are the murder rates per 100,000 people for those nations versus the United States.

United States 5.0

Japan 0.46

Spain 0.87

Switzerland 0.71

France 1.31

Australia 1.20

Korea 2.9

Israel 2.1

Finland 2.3

Sweden 1.0

Iceland 0.31

Crime rates directly lower life expectancy. Clearly the fact that ten times as many Americans, per 100,000, are being murdered than Japanese has an impact on life expectancy rates. Even Korea, which comes closest to the U.S. in this unfortunate race, has a murder rate almost half what it is in America.

Even Americans, in the same health care system, have dramatically different life spans. Unlike most the countries listed at the top of the life expectancy chart, the United States is a very diverse country. At the top of the global list are the Japanese. Asian Americans live longer than Americans in general, though both have the same health care system. They don’t have the same diets, don’t have the same habits, and don’t behave in exactly the same ways. A study from Harvard found that “15-year-old blacks in high-risk city areas were three to four times more likely than Asians to die before age 60, and four to five times more likely before age 45.”

Here is what Harvard said about the differences within the United States:

The researchers attribute such gaps to injuries and chronic diseases, including heart disease, cancer, and diabetes. These killers, in turn, are a consequence of well-known and largely controllable risk factors such as smoking, alcohol use, obesity, high blood pressure, and high cholesterol. In high-risk urban black communities, male mortality is increased by homicides and exposure to AIDS.

Not only do the nations at the top of life expectancy charts have different lifestyles, they are also more likely to be culturally and ethnically homogeneous. What the Harvard study found was: “Disparities in mortality across the eight Americas, each consisting of millions or tens of millions of Americans, are enormous by international standards.” In other words, differences in life expectancy within the US are greater than the differences between the US and other wealthy nations. And they say, “Observed disparities in life expectancy cannot be explained by race, income or basic health-care access and utilization alone.”

When they started looking at subgroups within the US they found huge variations. Asian females in America had an average life expectancy of 86.7, for Asian females in Bergen County, New Jersey they found it was 91. Both are better than the average life expectancy in Japan, which tops the list in the Daily Mail. In fact, if you were to compare only those Americans most like the residents of the nations at the top of the OECD list—that is white Americans—the differences in life expectancy rates disappear.

The chart below is from the Harvard study. America 3, which is the top line, is for white, Middle America. At the bottom is America 8, which is defined as high-risk urban blacks. Their average life expectancy is 15.4 years lower than that of Asian Americans.
Another factor, which dramatically impacts life expectancy rates, is infant mortality rates. Now, if all infant mortality were caused by health care issues, and all countries defined infant mortality the same, there would not be a problem. But that is not the case.

The U.S. has a higher infant mortality rate, which means lower life expectancy overall. One reason for this is that we define infant mortality more strictly than do other nations. Let us comparea child that is born weighing just under a pound in the United States, who dies shortly after birth. That is counted as a live birth and added to the numbers that determine life expectancy. The same child, in Austria or Germany, is not considered a live birth and has no impact on life expectancy rates. In Switzerland, which has a higher life expectancy than us, a newborn who dies, but is less than 30 centimeters in length is not considered live born and doesn’t go into their life expectancy rates. In the U.S. the same child is included. In both Belgium and France (high on the list) a birth before 26 weeks of pregnancy is considered lifeless, even if the child is breathing. In the U.S. the child is considered alive and counts against our life expectancy rate.

Factors that lower infant mortality include “fewer teen pregnancies, married as opposed to single mothers, less obesity and smoking, more education and moms pregnant with babies that they are utterly intent on having.” These are not controllable by the health care system in any direct manner.

That many, many factors determine life expectancy is indicated by life expectancy rates in two U.S. territories. I doubt many people would say that the health care system in Puerto Rico and the Virgin Islands is inherently better than it is in the mainland of the United States. Yet the life expectancy in both places is higher than the average on the mainland.

What is meaningful are other measures. For instance, how does the treatment rate for Americans compare to other nations, such as Canada, for instance? Or, how about using cancer survival rates? These things directly measure the amount of care Americans receive and outcomes. In the first, you will see Americans, with the diseases being investigated in the study, have higher treatment rates than do Canadians. In the second, we see that cancer treatment in the U.S. is more effective. These measure health directly, and don't mix in messy factors like accident rates, obesity, teen-age pregnancy, different definition of infant mortality, and the like.